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Competent for Unsupervised Practice: Use of Pediatric Residency Training Milestones to Assess Readiness
Su-Ting T Li1, Daniel J Tancredi, Alan Schwartz
1S.-T.T. Li is associate professor, vice chair of education, and pediatric program director, Department of Pediatrics, University of California, Davis, Sacramento, California. D.J. Tancredi is associate professor, Department of Pediatrics and Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California. A. Schwartz is Michael Reese Endowed Professor of Medical Education, associate head, and director of research, Department of Medical Education, and research professor, Department of Pediatrics, University of Illinois College of Medicine, Chicago, Illinois. A.P. Guillot is professor, Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vermont. A.E. Burke is professor and pediatric program director, Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, Ohio. R.F. Trimm is professor, vice chair, and pediatric program director, Department of Pediatrics, University of South Alabama, Mobile, Alabama. S. Guralnick is associate professor, director of graduate medical education, and designated institutional officer, Office of Academic Affairs, Winthrop University Hospital, Mineola, New York. J.D. Mahan is professor, vice chair, and pediatric and pediatric nephrology fellowship program director, Department of Pediatrics, Nationwide Children's Hospital/Ohio State University, Columbus, Ohio. K.A. Gifford is assistant professor and pediatric program director, Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
Pediatric residents show varied skill progression during training, with most achieving a competent (≥3) milestone rating by graduation. An expectation of mastery (≥4) for all subcompetencies upon graduation is unrealistic, suggesting a more attainable goal of competence.
Area of Science:
- Medical Education
- Pediatric Residency Training
- Competency-Based Medical Education
Background:
- Pediatric residency programs utilize milestone assessments to evaluate trainee clinical skills progression.
- Understanding the distribution of these assessments is crucial for setting realistic training expectations.
Purpose of the Study:
- To describe clinical skills progression in pediatric residency using milestone assessment data.
- To determine realistic milestone expectations for graduating pediatric residents.
Main Methods:
- A multi-institutional cohort study analyzed milestone data for 2,030 pediatric residents across 47 programs.
- Milestone assessments were evaluated across 21 subcompetencies, typically using a 5-level rating scale.
Main Results:
- Significant variation in milestone ratings within training levels decreased as residents advanced.
- Most graduating residents (78.9%) achieved a rating of ≥3 in all subcompetencies; only 21.1% reached ≥4.
- Professionalism and communication skills were rated highest, while quality improvement was rated lowest.
Conclusions:
- Pediatric residents enter with diverse skill levels, and variability decreases with training.
- A milestone rating of ≥3 (competent) is a more realistic expectation for graduation than ≥4 (proficient).
- Identifying areas for targeted training can optimize resident skill development.
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